Many men wonder whether Anavar (oxandrolone), an anabolic steroid, can help with erectile dysfunction. The short answer is no—Anavar does not improve erectile function and may actually worsen it. While some men initially experience increased libido when starting anabolic steroids, prolonged use disrupts the body's natural hormone production, often leading to erectile dysfunction, reduced fertility, and other sexual health problems. Anavar is not licensed in the UK, and its non-medical use carries significant legal and health risks. This article examines the relationship between Anavar and erectile function, the risks involved, and evidence-based treatments available through the NHS.

What Is Anavar and How Does It Work?

Anavar is the brand name for oxandrolone, a synthetic anabolic-androgenic steroid (AAS) first developed in the 1960s. It was originally prescribed for conditions involving muscle wasting, severe weight loss, and certain chronic illnesses. Oxandrolone is not currently licensed in the United Kingdom; any clinical use would be as an unlicensed medicine under specialist supervision.

In the UK, oxandrolone is classified as a Class C controlled substance under the Misuse of Drugs Act 1971 and is listed in Schedule 4 (Part II) of the Misuse of Drugs Regulations 2001. Possession for personal use is not a criminal offence, but it is illegal to supply, manufacture, or import with intent to supply. Importation by post or courier for personal use is also prohibited. The Medicines and Healthcare products Regulatory Agency (MHRA) strongly advises against purchasing anabolic steroids from unregulated online sources, as products may be counterfeit, contaminated, or incorrectly dosed.

Anavar works by mimicking the effects of testosterone, the primary male sex hormone. It binds to androgen receptors in muscle tissue, promoting protein synthesis and nitrogen retention, which leads to increased muscle mass and strength. Oxandrolone has a relatively lower androgenic-to-anabolic ratio compared with some other anabolic steroids, meaning it may produce fewer masculinising side effects in some contexts. However, androgenic and virilising adverse effects can still occur, particularly with higher doses or prolonged use.

The drug is metabolised primarily in the liver and has a half-life of approximately 9 to 10 hours. While it was designed for legitimate medical use, Anavar has been widely misused in bodybuilding and athletic circles due to its reputation for promoting lean muscle gains. Non-prescribed use carries significant health risks, including hormonal disruption, liver toxicity, cardiovascular complications, and effects on sexual function. Patients considering or currently using Anavar without medical supervision should be aware of the legal implications and potential health consequences, particularly regarding reproductive and sexual health.

The Link Between Anabolic Steroids and Erectile Function

The relationship between anabolic-androgenic steroids and erectile function is complex and often paradoxical. While some men initially report increased libido when starting steroid use—due to elevated androgen levels—prolonged or high-dose use frequently leads to erectile dysfunction (ED) and other sexual health problems.

Anabolic steroids, including Anavar, disrupt the body's natural hypothalamic-pituitary-gonadal (HPG) axis. When exogenous androgens are introduced, the hypothalamus detects elevated hormone levels and reduces production of gonadotropin-releasing hormone (GnRH). This suppresses the pituitary gland's release of luteinising hormone (LH) and follicle-stimulating hormone (FSH), which in turn causes the testes to reduce or cease natural testosterone production. This condition, known as hypogonadotropic hypogonadism, can persist for months or, in some cases, years after stopping steroid use, though the duration and severity vary widely between individuals.

The consequences for erectile function are significant:

• Reduced endogenous testosterone: Natural testosterone production may fall to very low levels, causing decreased libido and difficulty achieving or maintaining erections.

• Testicular atrophy: Prolonged suppression leads to shrinkage of testicular tissue, further impairing hormone production.

• Altered oestrogen metabolism: Some anabolic steroids can be converted to oestrogen through aromatisation, leading to hormonal imbalance that affects sexual function. Oxandrolone itself, as a dihydrotestosterone (DHT) derivative, is non-aromatisable, but this mechanism is relevant to other commonly misused AAS such as testosterone.

• Psychological factors: Mood changes, depression, and anxiety associated with steroid use and withdrawal can contribute to ED.

There is no clinical evidence that Anavar improves erectile dysfunction. In fact, the medical literature consistently demonstrates that anabolic steroid misuse is a risk factor for developing ED, particularly after discontinuation when natural testosterone production remains suppressed. Men experiencing erectile problems while using or after stopping Anavar should seek medical evaluation from their GP. NICE Clinical Knowledge Summaries (CKS) recommend assessment of erectile dysfunction with a comprehensive history, physical examination, and investigations including two separate morning testosterone measurements (taken between 08:00 and 11:00) if hypogonadism is suspected. Referral to endocrinology may be appropriate for men with confirmed low testosterone, particularly if related to anabolic steroid use.

Potential Risks of Using Anavar for Sexual Health

Using Anavar without medical supervision poses substantial risks to sexual and reproductive health, extending well beyond erectile dysfunction. Understanding these risks is essential for anyone considering or currently using this substance.

Hormonal disruption represents the most significant concern. As previously discussed, Anavar suppresses the HPG axis, leading to dramatically reduced natural testosterone production. Recovery of normal hormonal function after cessation is variable and can take 6 to 12 months or longer in many cases. The risk of prolonged or incomplete recovery increases with higher doses, longer duration of use, and concurrent use of multiple anabolic steroids. During this recovery period, men commonly experience persistent erectile dysfunction, loss of libido, fatigue, and mood disturbances. In some individuals, permanent impairment of testicular function may occur, though the evidence is largely observational and individual outcomes vary.

Fertility impairment is another serious consequence. The suppression of FSH and LH reduces sperm production (spermatogenesis), potentially causing oligospermia (low sperm count) or azoospermia (absence of sperm). While fertility often recovers after stopping steroid use, this is not guaranteed. Men concerned about fertility should be offered semen analysis and, if appropriate, referral to a fertility or endocrinology specialist.

Additional sexual health risks include:

• Prostate effects: Anabolic steroids may increase prostate volume and prostate-specific antigen (PSA) levels. The relationship between AAS use and benign prostatic hyperplasia (BPH) or lower urinary tract symptoms (LUTS) is not fully established, but monitoring may be warranted in symptomatic individuals.

• Cardiovascular effects: Anavar can adversely affect lipid profiles, increasing LDL cholesterol and decreasing HDL cholesterol, which raises cardiovascular disease risk—a major contributor to erectile dysfunction. Cardiovascular risk assessment (e.g., QRISK) should form part of the evaluation of men with ED.

• Liver toxicity: As a C17-alpha alkylated steroid, oxandrolone can cause hepatotoxicity. Recognised adverse reactions include elevated liver enzymes, cholestatic jaundice, peliosis hepatis, and, rarely, hepatic tumours. Regular monitoring of liver function is essential if the drug is used clinically.

• Psychological effects: Mood swings, aggression, anxiety, and depression associated with steroid use can significantly impact sexual relationships and function.

The MHRA warns against purchasing anabolic steroids from unregulated sources, as products may be counterfeit, contaminated, or contain incorrect dosages, further increasing health risks. Patients are encouraged to report suspected adverse drug reactions via the MHRA Yellow Card Scheme. Men experiencing sexual dysfunction should consult their GP rather than self-medicating with anabolic steroids, which are likely to worsen rather than improve the condition.

Evidence-Based Treatments for Erectile Dysfunction in the UK

Erectile dysfunction is a common condition affecting approximately half of men aged 40–70 to some degree. Fortunately, effective, evidence-based treatments are available through the NHS and private healthcare providers in the UK.

Initial assessment should begin with a GP consultation. The doctor will take a comprehensive history, including cardiovascular risk factors, medications, psychological factors, and lifestyle habits. Physical examination and investigations may include:

• Blood tests: two separate morning testosterone levels (08:00–11:00), HbA1c or fasting glucose, lipid profile, thyroid function; consider prolactin, LH, and FSH if hypogonadism suspected

• Blood pressure measurement and cardiovascular risk assessment (e.g., QRISK)

• Assessment for underlying conditions (diabetes, cardiovascular disease, hypogonadism)

NICE Clinical Knowledge Summaries (CKS) recommend a stepwise approach to ED management:

First-line pharmacological treatment involves phosphodiesterase type 5 (PDE5) inhibitors, including:

• Sildenafil (Viagra)

• Tadalafil (Cialis)

• Vardenafil (Levitra)

• Avanafil (Spedra)

These medications are effective in approximately 70% of men and work by enhancing the natural erectile response to sexual stimulation. Sexual stimulation is required for these drugs to work. They are contraindicated in men taking nitrates or nicorandil (risk of severe hypotension) and should be used with caution in men taking alpha-blockers (risk of postural hypotension). Common adverse effects include headache, flushing, dyspepsia, and nasal congestion. PDE5 inhibitors may be available on NHS prescription depending on clinical need and local commissioning arrangements, or can be obtained privately. Prescribing information, dosing, and safety details are available in the British National Formulary (BNF) and electronic Medicines Compendium (eMC) Summaries of Product Characteristics (SmPCs).

Lifestyle modifications form an essential component of ED management:

• Smoking cessation

• Reducing alcohol consumption

• Regular physical exercise

• Weight management

• Stress reduction

Psychological interventions, including cognitive behavioural therapy (CBT) or psychosexual counselling, benefit men where psychological factors contribute to ED.

Testosterone replacement therapy (TRT) may be appropriate for men with confirmed hypogonadism (low testosterone on two separate morning measurements), but should only be prescribed by specialists after thorough evaluation. TRT is not recommended for men with normal testosterone levels and will not improve ED in eugonadal men.

Second-line treatments for men who cannot use or do not respond to PDE5 inhibitors include:

• Vacuum erection devices

• Intracavernosal injections (alprostadil)

• Intraurethral alprostadil

• Penile prosthesis surgery (in selected cases)

Referral should be considered in the following circumstances:

• Suspected hypogonadism or anabolic steroid-related hormonal suppression: endocrinology referral

• Penile deformity, Peyronie's disease, or consideration of penile prosthesis: urology referral

• Refractory ED not responding to oral therapy

• Complex psychological or relationship factors: psychosexual therapy

Men who have used anabolic steroids and subsequently developed ED should inform their healthcare provider, as this may require specialist endocrinology referral to assess and manage hormonal recovery. Self-medication with further steroids, including Anavar, is not an evidence-based treatment and will likely worsen the underlying problem. With appropriate medical care, most men with ED can achieve significant improvement in sexual function and quality of life.

Frequently Asked Questions